Endotoxemia contributes to the immune paralysis in patients with cirrhosis

Lin, Chun‐Yen; Tsai, I-Fan; Ho, Yu‐Pin; Huang, Ching-Tai; Lin, Yung‐Chang; Lin, Chan‐Yu; Tseng, Shu-Chin; Lin, Wei-Wen; Chen, Wei‐Ting; Sheen, I‐Shyan

doi:10.1016/j.jhep.2006.12.018

Cited by 134 publications

(131 citation statements)

References 38 publications

(55 reference statements)

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“…Because, in our experience, the expression of HLA-DR on monocytes was highly related to the effector functions of the monocytes [13], we documented this expression pattern as a good predictor for late bacterial complications and mortality in severe acute pancreatitis [11]. Similar observations were reported in patients with sepsis and decompensated liver cirrhosis [13,14].…”

Section: Introductionsupporting

confidence: 77%

Tumor necrosis factor–α and interleukin-10 contribute to immunoparalysis in patients with acute pancreatitis

Chiu

Sheen

et al. 2011

Human Immunology

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Section: Introductionsupporting

confidence: 77%

Tumor necrosis factor–α and interleukin-10 contribute to immunoparalysis in patients with acute pancreatitis

Chiu

Sheen

et al. 2011

Human Immunology

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“…There is a growing body of evidence that they suffer from a complex and not fully understood cirrhosis-associated immune dysfunction syndrome [12]. The evolving explanation for this impaired immunity includes: a decrease in T-helper cells and phagocytic potential of both monocytes and neutrophils [13], an increased level of cyclooxygenase-derived eicosanoid prostaglandin E2 [14], and a decreased HLA-DR expression on monocytic cells defined as immune paralysis [15].…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

Elzouki

Neffati

Rasoul

et al. 2018

GE Port J Gastroenterol

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Background:The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results. Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients. Materials and Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital-, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Cirrhosis was clinically diagnosed by a combination of physical, biochemical, radiological, and endoscopic findings, or by liver biopsy. Results: A total of 333 patients were included in this study, of whom 171 (51.4%) used PPIs and 162 (48.6%) did not use PPIs. PPI users were significantly older in age (p = 0.001). There was no statistical difference between the 2 groups in sex distribution and etiology of cirrhosis (p > 0.05 for both parameters). PPI users had a significantly higher incidence of overall bacterial infection (38%) than non-PPI users (13.6%), p = 0.0001. Statistical significance is observed specifically for SBP and chest infection (p = 0.0006 and p = 0.01, respectively). In multivariate analysis, older age (> 60 years; OR = 1.246, 95% CI 1.021-08.486; p = 0.02), and PPI use (OR = 2.149, 95% CI 1.124-06.188; p = 0.01) were independent predicting factors for SBP and overall bacterial infection. Conclusion: The present study shows that PPI use, as well as older age (> 60 years), was an independent predicting factor for the development of overall infection and SBP in hospitalized cirrhotic patients. Unless it is indicated, PPI therapy should be avoided in this group of patients, particularly in those older than 60 years of age. Resumo Introdução: A associação entre infeções bacterianas e os Inibidores da bomba de protões (IBPs) tem vindo a ser estudada com resultados discutíveis. Objetivo: O objetivo deste estudo foi investigar a relação entre IBPs e o desenvolvimento de peritonite bacteriana espontânea (PBE) ou outras infeções bacterianas em doentes cirróticos. Material e Métodos: Doentes consecutivos com cirrose hospitalizados entre 2007 e 2012 no Hamad General HospitalQatar foram selecionados e classificados como utilizadores ou não utilizadores de IBPs de acordo com o seu consumo nos 90 dias prévios ao internamento. A cirrose foi clinicamente diagnosticada por uma combinação de achados no exame físico, no estudo bioquímico, radiológico e endoscópico; ou por biopsia hepática. Resultados: Um total de 333 doentes foi incluído neste estudo, 171 (51.4%) medicados com IBPs e 162 não (48.6%). Os utilizadores de IBPs eram significativamente mais velhos (p = 0.001). Não se observaram diferenças estatísticas entre os dois grupos no que se refere ao sexo ou etiologia da cirrose (p > 0.05 para os dois parâmetros). A incidência global de infeções bacterianas foi significativamente superior nos utilizadores de IBPs (38%) do ...

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“…It is widely known that bacterial translocation causes a chronic endotoxemia in cirrhotic patients. As a consequence, they develop a condition of tolerance associated with an impaired production of LPSinduced pro-inflammatory cytokines, such as TNF-a and NO, by monocytes [14]. An impaired cytokines release by stimulated alveolar macrophage has also been reported in cirrhotic patients [15].…”

Section: Characteristicsmentioning

confidence: 98%

“…Crude could be provided by the mechanisms of ''endotoxin tolerance,'' which has been recently studied in liver cirrhosis [14]. Endotoxin or lipopolysaccharide (LPS) is a component of the cell wall of gram-negative bacteria and it has been commonly used to induce inflammatory response in experimental models.…”

Section: Characteristicsmentioning

confidence: 99%

Risk Factors and Clinical Characteristics Associated with Hospitalization for Community-Acquired Bacterial Pneumonia in HIV-Positive Patients According to the Presence of Liver Cirrhosis

et al. 2009

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Endotoxemia contributes to the immune paralysis in patients with cirrhosis

Cited by 134 publications

References 38 publications

Tumor necrosis factor–α and interleukin-10 contribute to immunoparalysis in patients with acute pancreatitis

Tumor necrosis factor–α and interleukin-10 contribute to immunoparalysis in patients with acute pancreatitis

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

Risk Factors and Clinical Characteristics Associated with Hospitalization for Community-Acquired Bacterial Pneumonia in HIV-Positive Patients According to the Presence of Liver Cirrhosis

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